Bienvenidos, Corredores!

As you may be aware, Section 12006 of the 21st Century Cures Act, along with CMS guidance, required states to implement Electronic Visit Verification (EVV) for Personal Care Services by January 1, 2021, and for Home Health Care Services by January 1, 2023. As of 2026, EVV requirements are fully implemented, requiring applicable services to be electronically verified and documented, including the member receiving care, caregiver, service location, date, and type of service provided.   Next Steps To ensure EVV data is accurately captured for providers delivering in-scope EVV services, Fidelis Care will require all providers — including existing EDI and Enterprise (ENT)

Fidelis Care would like to inform providers of an important update from New York State regarding Child Health Plus (CHPlus) eligibility requirements. What’s Changing? Effective July 1, 2026, continuous eligibility beyond 12 months will no longer be permitted for children from birth through age six enrolled in Child Health Plus. This change aligns with federal guidance from the Centers for Medicare & Medicaid Services (CMS), which no longer allows states to approve or renew waivers that extend eligibility beyond 12 months for children in Medicaid or CHIP programs. What This Means for Members Beginning July 1, 2026: Children enrolled in CHPlus will be subject to

Join us for a focused overview of the CoC+ program and how it supports coordinated, patient-centered care. What we will cover: CoC+ program overview and key components Quality, high utilization, risk and actionable insights How to use Centene Clinical Action (CCA) /CoC+ (Agenda submissions) Ways to support documentation and continuity of care Who Should Attend: This session is intended for provider office staff involved in patient care coordination and performance improvement, including: Providers / Clinicians Care coordinators and care management staff Billing and coding specialists Office managers or administrators  Teams using CCA/CoC+ We appreciate your partnership and look forward to helping you get the

Fidelis Care would like to advise Providers of an update to the Private Duty Nursing (PDN) manual as of July 1, 2026.   Member Demographic Information Form Detailed in section 6.11 of the Private Duty Nursing (PDN) manual, this form is to be completed by the Billing Provider. If support is needed for completion, members’ Care Manager should be contacted. The form includes a home safety attestation and applicable member information regarding school and day program. This form must be submitted with new PDN cases and with 12-month documentation renewal requests, along with the required documentation detailed in Section 6.1 of the PDN

As a reminder, providers now have access the Availity Clinical Quality Validation (CQV) tool designed to help providers close care gaps quickly and accurately. Through the Availity Essentials portal, CQV streamlines documentation and improves quality scores while reducing administrative burden.   What is CQV? Clinical Quality Validation (CQV) is an Availity Essentials application that helps providers: ·         Monitor targeted care gaps/measures for the measurement year. ·         View and respond to payer requests for clinical/medical data. ·         Improve quality scores and reduce administrative burden.   Benefits ·         Streamlined workflow for care gap closure. ·         Faster access to clinical data. ·         Enhanced provider experience across multiple markets.   Availity-led Training for Providers: A live webinar, Centene